Lecture 7 Muscle and tendon injury

Question 1

Tendon

Answer 1

• Collagen tissue, mostly type 1, makes up 80% of tissue
• connects muscle to bone
• transfer force from muscles into skeletal system
• excellent tensile properties

Question 2

Enthesis

Answer 2

• junction between a tendon and a bone
• fibrocartilage
• enthesopathy, increases the connection points

Question 3

Myotendinous junction (MTJ)

Answer 3

Connection between tendon and muscle
- Susceptible for injury

Question 4

Tendon: stress-strain curve

Answer 4

• Relationship between stress and deformation of tendons is the same as for ligaments

Question 5

Adaption to training

Answer 5

• Tendons adapt to training by increasing cross-sectional area
• Tendon loading every 2-3 days
• compared to muscles, it takes longer time to gain tendon strength

Question 6

Repetitive tendon injuries

Answer 6

tendons are most often affected by repetitive injuries

Question 7

Acute tendon injuries

Answer 7

Direct traume, rupture

Question 8

Tendinopathy

Answer 8

• Umbrella term used for tendon problems
• Mechanism
  -> Repetitive tensile (or compressive) loading (e.g., sprinting jumping, changing direction) -> repetitive micro traumas
  -> inadequate recovery between loadings

Question 9

Tendon pathology cook-purdah model

Answer 9

• Reactive tendinopathy: Non-inflammatory, structural changes & thickening of stressed tendon area
• Tendon disrepair: Worsening tendon pathology, tendon structure becomes disorganized
• Degenerative tendinopathy: Chronic stage

Question 10

Intrinsic risk factors

Answer 10

• older age, male sex, menopause, genetics, systemic conditions, medications, biomechanics, previous injury

Question 11

Extrinsic risk factors

Answer 11

• training loads, spike in loads, periods of reconditioning, biomechanical change

Question 12

Diagnosis

Answer 12

• History: Symptoms often
  progress
• First pain after
  exercise
• Then pain at the start
  of an activity
• Finally pain both
  during and after
  activity
• Physical Examination; Palpation –tenderness
• Imaging: US, MRI

Question 13

Management (Article)

Answer 13

• Education of patients
• load monitoring
• pain monitoring
• exercise based progressive rehabilitation program

Question 14

Exercise based rehabilitation programs for lower limb tendinopathy

Answer 14

Stage 1: isometric exercises; against a fixed load, static contraction without any visible movement
Stage 2: isotonic and heavy slow resistance exercises
Stage 3: Increase in speed and energy storage exercises
Stage 4: Energy storage and release and sport specific exercises

Question 15

Other treatments

Answer 15

• Shock wave therapy, laser, and ultrasound
• Medications
• Injectable therapies
• Passive treatments
• Experimental treatments
• Surgery

Question 16

Tendon rupture

Answer 16

• Acute rupture of a normal and healthy tendon is rare
• commonly occur in athletes and recreational exercisers aged 30-50 years

Question 17

Eccentric for generation

Answer 17

• Mid-tendon area, usually during changing direction
• bone-tendon junction

Question 18

Achilles tendon, suprespinatus tendon

Answer 18

• partial rupture
• complete rupture

Question 19

Achilles tendon rupture

Answer 19

• Active mid-aged recreational athletes
• high risk of injury: rapid direction changes, jumps
• usually occur without warning (degenerative changes)

Question 20

Mechanism- achilles

Answer 20

• Strong contracture of the lower leg musculature, with simultaneous extension
  -> eccentric loading of the tendon

Question 21

Diagnosis-achilles

Answer 21

• Acute, intense pain
• audible ‘SNAP’
• reduced power in plantar flexion
• ‘gap’ in the tendon tissue
• bruise and swelling
• ultrasound/ MRI

Question 22

Treatment and rehabilitation

Answer 22

• conservative vs. surgical repair (end to end suture)
• cast
• rehabilitation and return to sport

Question 23

Preventions strategies?- achilles

Answer 23

Appropriate loading, strength and conditioning, neuromuscular training

Question 24

Muscle

Answer 24

• Function: generate force
• Muscle cells (fibres)

Question 25

Muscle actions

Answer 25

• Isometric
• Isotonic
• Concentric
• Eccentric (most risky for injury)

Question 26

Muscle: adaption to training

Answer 26

• raid response to training
• neural and muscular factors
• muscle fibres increase their cross-sectional area (hypertrophy)

Question 27

Muscle injury types

Answer 27

• Direct trauma: contusion, muscular laceration
• Distension ruptures: muscle strain
• Other: DOM’s, myositis ossificans, muscle cramps

Question 28

Muscle contusion

Answer 28

• Muscle bruise
• external force
• contact sports, team ball sports
• most common sit is the quadriceps

Question 29

Muscle strain

Answer 29

• tensile force
• usually close to MTJ
• hamstrings, quadriceps, gastrocnemius
• pop, bump, swelling
• Pain on active contraction and passive stretch, reduced contration strength, decreased ROM and loss of function

Question 30

Clinical grading of muscle strains

Answer 30

Grade 1(mild): few ‘fiber’ injury, minimal loss of strength and motion
Grade 2(moderate): tissue damage, decreased ability to contract and decreased ROM
Grade 3(severe): complete tear, complete loss of muscle function

Question 31

Hamstring rupture

Answer 31

• Two injury types
• Type I – Sprinting-related hamstring strain (biceps femoris)
• Type II – Stretching-related hamstring strain (semimembranosus)

Question 32

Type I Hamstring diagnosis

Answer 32

• History & Physical examination
• Mechanism
• Palpation
• Imaging
• MRI

Question 33

Type II hamstring diagnosis

Answer 33

• History & Physical examination
• Mechanism
• Palpation
• Imaging
• MRI

Question 34

Muscle injury: healing

Answer 34

• Destructive Phase (Hemostasis & Inflammation)
• Repair Phase (Proliferation)
• Maturation Phase (Remodeling)

Question 35

Rehabilitation

Answer 35

• Mobilization
• progressive strengthening
• functional exercises (e.g., running program)
• other body regions

Question 36

Prevention of hamstring strains

Answer 36

stretching- no evidence for sport